后外侧入路联合后内侧入路治疗KlammerⅡ、Ⅲ型后侧Pilon骨折的疗效

The efficacy of posterolateral approach combined with posteromedial approach in the treatment of Klammer type II and III posterior pilon fractures

目的探讨后外侧入路联合后内侧入路治疗KlammerⅡ、Ⅲ型后侧Pilon骨折的疗效。方法我院行择期内固定手术的100例KlammerⅡ、Ⅲ型后侧Pilon骨折患者,其中行后外侧入路联合后内侧入路内固定治疗45例(研究组),行后外侧入路内固定治疗55例(对照组)。对比两组围术期相关指标,术后1年骨折复位效果,术后1年踝关节功能恢复情况,术前、术后1年生活质量(SF-36评分)差异,并记录术后1年内并发症出现情况。结果研究组手术时间、术后1周VAS评分、住院时间均低于对照组(P<0.05)。术后1年,研究组骨折复位效果、踝关节功能恢复优于对照组,术后并发症发生率低于对照组;两组SF-36评分较术前均上升,且研究组高于对照组(P<0.05)。结论对于KlammerⅡ、Ⅲ型后侧Pilon骨折患者,应用后外侧入路联合后内侧入路治疗效果显著,不仅可缩短手术及住院时间,有效降低术后疼痛,骨折效果较好,促进患者踝关节功能恢复,提升患者的生活质量,且术后并发症较少,具有较好的应用价值。

Objective To explore the effects of posterolateral approach combined with posteromedial approach in the treatment of Klammer type II and III posterior pilon fractures.Methods A total of 100 patients with Klammer type II and III posterior pilon fractures who underwent internal fixation surgery in our hospital were selected as the research subjects.Among them,45 patients were treated with posterolateral approach combined with posteromedial approach internal fixation(study group),and 55 patients were treated with posterolateral internal fixation(control group).The perioperative related indexes,fracture reduction effects after 1 year of surgery,ankle function recovery after 1 year of surgery and quality of life(SF-36 score)before surgery and after 1 year of surgery were compared between the two groups,and the occurrence of complications were recorded within 1 year after surgery.Results The operative time,VAS score and hospital stay in the study group were significantly lower or shorter than those in the control group(P<0.05).After 1 year of surgery,the fracture reduction effects and ankle function recovery in the study group were significantly better than those in the control group(P<0.05).SF-36 scores in the two groups were significantly higher than those before surgery,and SF-36 score in the study group was significantly different from that in the control group during the same period(P<0.05).The incidence rates of postoperative complications in the study group were significantly lower than those in the control group(P<0.05).Conclusion For patients with Klammer type II and III posterior pilon fractures,posterolateral approach combined with posteromedial approach has a significant therapeutic effect.It can not only shorten the operative time and hospital stay,effectively reduce postoperative pain,have a good fracture effects,promote the ankle function recovery,improve the quality of life,but also has few postoperative complications and good application value.